Treatment of anxiety disorder in patients with mood disorders

Symptoms compatible with a diagnosis of anxiety disorder frequently complicate the course of affective illness. Patients with depression may have panic attacks, phobias, severe social anxiety, obsessions, compulsions, and generalized anxiety. If the affective disorder is the primary condition, its treatment should be sufficient in most instances to relieve the concomitant anxiety symptoms. Thus, judicious choice of antidepressant therapy for treatment of major and atypical depression will usually resolve associated panic attacks, generalized anxiety, phobias, and compulsions. It must be recalled, however, that antidepressant therapy usually takes between 4 and 6 weeks to have full clinical effect; in the interim, anxiety symptoms may be the most troubling and disabling aspect of the illness. Therefore, using antianxiety agents in treating depressed patients who also have anxiety symptoms is often recommended while waiting for the antidepressant to work. Benzodiazepines are extremely useful for short-term treatment of most anxiety symptoms in depressed patients. The dose should be kept to the lowest possible to relieve symptoms, and the medication should be tapered and then discontinued once the underlying affective disturbance is relieved. Buspirone is also very effective in treating generalized anxiety disorder and may be used in conjunction with antidepressants of most classes. A wide range of behavioral and cognitive techniques may also help relieve anxiety symptoms in the depressed patient.